Is there a role for Platelet-Rich Plasma (PRP) therapy in a 45-year-old female patient with mild Acromioclavicular (AC) joint arthropathy and signs suggestive of frozen shoulder?

PRP for AC Joint Arthropathy and Frozen Shoulder

For frozen shoulder, offer PRP injection as it provides superior and more durable pain relief and functional improvement compared to corticosteroids, with better safety profile; however, for AC joint arthropathy specifically, evidence is insufficient to recommend PRP.

Evidence for Frozen Shoulder (Adhesive Capsulitis)

Efficacy Compared to Standard Treatments

• PRP demonstrates statistically significant superiority over corticosteroids and other control treatments in multiple outcome measures at 12 weeks, including pain reduction (VAS), functional scores (UCLA, DASH, SPADI), and both active and passive range of motion in all directions except passive extension 1

• The therapeutic effect of PRP is more durable than corticosteroids, with VAS scores continuing to decline in the PRP group at 6 months while pain scores rebounded in the corticosteroid control group 2

• Meta-analysis of randomized controlled trials shows PRP provides significant improvements in:

  • Pain scores at 1 month (SMD: -0.46) and 3 months (SMD: -0.87) 3
  • Active flexion (MD = 12.70°), active abduction (MD = 13.54°), and active external rotation (MD = 10.50°) 1
  • SPADI total score (MD = -16.87), SPADI pain (MD = -5.38), and SPADI disability (MD = -11.00) 1

Clinical Protocol for Frozen Shoulder

• Administer a single intra-articular injection of 2 mL PRP into the glenohumeral joint under ultrasound guidance for accurate delivery 4, 2

• Combine PRP injection with structured home-based exercise therapy (10 minutes daily of stretching and strengthening exercises) to optimize outcomes 4, 2

• Evaluate response at 1 week, 1 month, 3 months, and 6 months post-injection, with peak benefits typically observed at 3-6 months 2, 1

Safety Profile

• PRP is safer than corticosteroids, with most studies reporting no adverse effects and only rare reports of common joint puncture complications (transient swelling and pain) 1

• Unlike corticosteroids, PRP carries no risk of osteonecrosis or other steroid-related complications 1

• PRP is autologous, minimally invasive, and has minimal immunogenicity risk 5

Mechanism Supporting Use in Frozen Shoulder

• PRP may reduce histological severity of synovial membrane changes in the posterior glenohumeral joint, potentially preventing or treating capsular remodeling that characterizes frozen shoulder 6

• Platelet α-granules release growth factors and cytokines that promote angiogenesis, cell migration, proliferation, and differentiation, creating a local environment conducive to tissue repair 7, 5

Evidence for AC Joint Arthropathy

Lack of Specific Evidence

• No high-quality evidence exists specifically for PRP treatment of AC joint arthropathy 7

• Guidelines addressing shoulder pathology focus on rotator cuff repair and glenohumeral joint conditions, not AC joint arthropathy 7

• The 2020 VA/DoD guidelines for osteoarthritis found insufficient evidence to recommend for or against PRP for knee or hip OA, with mixed and inconsistent results 7

Extrapolation Concerns

• Do not extrapolate evidence from knee/hip OA or frozen shoulder to AC joint arthropathy, as these represent different pathophysiologic processes and joint environments 7

• The American Academy of Orthopaedic Surgeons emphasizes that PRP evidence is condition-specific and cannot be generalized across different musculoskeletal disorders 7

Critical Implementation Requirements

Product Standardization

• Use anticoagulated blood (trisodium citrate) with gravitational centrifugation techniques to prepare PRP, as recommended by the International Society on Thrombosis and Haemostasis 7, 8

• Document platelet concentration, yield, purity, and activation status prior to clinical use to ensure consistency 8

• Recognize that different preparation methods result in significant variations in platelet yields, concentration, and biological activity, directly impacting clinical efficacy 7, 5

Patient Communication

• Set realistic expectations by explaining that PRP for frozen shoulder has good evidence support, but AC joint arthropathy lacks specific evidence 7, 1

• Clearly communicate that PRP is an autologous biologic therapy with growth factor-mediated tissue repair mechanisms, not a "stem cell" treatment 7, 5

Clinical Decision Algorithm

1. For frozen shoulder component: Offer PRP injection (2 mL intra-articular) combined with structured exercise therapy, with follow-up at 1,3, and 6 months 4, 2, 1

2. For AC joint arthropathy component: Use evidence-based treatments (NSAIDs, physical therapy, corticosteroid injection if needed), as PRP lacks supporting evidence for this specific indication 7

3. If patient insists on PRP for AC joint: Explain the lack of evidence, consider enrollment in a registry for post-market surveillance, and ensure informed consent documenting the experimental nature 7